MedicaidPrior AuthMedium impact
Yescarta™ (axicabtagene ciloleucel) (Revised)
Humana·KY · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Kentucky Medicaid updated its Yescarta (axicabtagene ciloleucel) prior authorization policy effective May 1, 2026. The policy covers CAR-T cell therapy for relapsed/refractory large B-cell lymphoma (2L and 3L indications) and follicular lymphoma in adults ≥18 years. Key requirements include prior authorization through Corporate Transplant Department, use with lymphodepleting chemotherapy, and exclusions for prior CD-19 targeted therapy, active hepatitis B/C, HIV/AIDS, and prior allogeneic transplant. Maximum one dose per lifetime applies.
Action Required
By May 1, 2026: Billing team must implement prior authorization workflow for Yescarta claims in Kentucky Medicaid. (1) Update billing system to flag all J9119 claims for mandatory prior auth submission to Humana Corporate Transplant Department (phone: 1-866-421-5663, fax: 502-508-9300, email: transplant@humana.com) before service delivery. (2) Create pre-authorization checklist requiring: large B-cell lymphoma or follicular lymphoma diagnosis verification, documentation of ≥2 prior systemic therapy lines (or 1L refractoriness for 2L indication), confirmation of relapsed/refractory status per policy criteria, patient age ≥18, confirmation of lymphodepleting chemotherapy use, and exclusion screening (no prior CD-19 therapy, CD-19 CAR-T, active hepatitis B/C, HIV/AIDS, prior allogeneic transplant). (3) Providers must submit prior auth requests with complete clinical documentation to Transplant Department; approval limited to 60 days per clinical review. (4) Update claim edits to deny J9119 claims submitted without prior authorization approval or exceeding lifetime one-dose limit. (5) Train front desk and billing staff on Kentucky Medicaid Yescarta requirements. Failure to obtain prior authorization will result in claim denials and patient liability.